Shorter Mean Overall Survival Research Articles

Predictors and survival outcomes of having less than 12 harvested lymph nodes in proctectomy for rectal cancer.

Current recommendations suggest that a minimum of 12 lymph nodes (LNs) should be harvested during curative rectal cancer resection. We aimed to assess predictors and survival outcomes of harvesting < 12 lymph nodes in rectal cancer surgery. A retrospective case-control analysis of factors associated with harvesting < 12 LNs in rectal cancer surgery was conducted. Data were derived from the National Cancer Database 2010-2019. Univariate and multivariate binary logistic regression analyses were performed to determine predictors of harvesting < 12 LNs. Association between harvesting < 12 LNs and 5-year overall survival (OS) was assessed using Cox regression and Kaplan Meier statistics. 67,529 patients (60.8% male; mean age: 61.2 ± 12.5years) were included. Median number of harvested LNs was 15 (IQR: 11-20); 27.1% of patients had < 12 harvested LNs. Independent predictors of harvesting < 12 LNs were older age (OR: 1.016;p < 0.001), neoadjuvant systemic treatment (OR: 1.522;p < 0.001), neoadjuvant radiation treatment (OR: 1.367;p < 0.001), longer duration of radiation therapy (OR: 1.003;p < 0.001) and abdominoperineal resection (OR: 1.071;p = 0.017). Higher clinical TNM stage and tumor grade, pull-through coloanal anastomosis, and minimally invasive surgery were independently associated with ≥ 12 harvested LNs. < 12 harvested LNs was independently associated with lower 5-year OS (HR: 1.24;p < 0.001) and shorter mean OS (96.7 vs 102.8months;p < 0.001) than ≥ 12 harvested LNs. Older age, open resection, and neoadjuvant therapy were independent predictors of < 12 harvested LNs. Conversely, higher clinical TNM stage and tumor grade, coloanal anastomosis, and minimally invasive surgery were predictive of ≥ 12 harvested LNs. < 12 LNs harvested was associated with lower OS.

The outcome of relapsed/refractory hodgkin's lymphoma patients post autologous bone marrow transplantation in a Baghdad Medical City Complex Center

BACKGROUND: Early autologous hemopoietic stem cell transplant is the best option for treatment of relapsed or refractory Hodgkin lymphoma (HL), which is the standard of care at the time being. The aim of this study was to evaluate the outcome of patients with relapsed/refractory (R/R) HL who received autologous hemopoietic stem cell transplant.METHODS: This is a cohort study with data obtained from the patient's sheets and then with follow-up from January/2014 to May/2017. Analysis involved 48 patients with R/R HL. Those patients received high-dose chemotherapy followed by autologous hemopoietic stem cell transplantation (ASCT). Disease status before ASCT, chemo-mobilization protocols, and stem cell collection and ASCT procedure were recorded. The posttransplantation complications and 30-day mortality were also recorded. Re-evaluation of disease status was done at day 100 post transplantation and the patients were followed up for any evidence of relapse or progression till the end of the study. Comparison of various predictors affecting overall survival (OS) and progression-free survival (PFS) was also performed.RESULTS: The 3-year PFS and OS for the patients with R/R Hodgkin disease who received ASCT were 80% and 70.2%, respectively, with various predictors affecting them. Patients with disease status before ASCT as partial remission and resistant have shorter mean OS and PFS that are not statistically significant (P = 0.325 for OS and 0.45 for PFS). Patients with the number of pretransplant treatment regimens more than 2 have a statistically significant shorter mean PFS and statistically nonsignificant OS (P = 0.4 for OS and 0.06 for PFS). The first 30-day posttransplantation mortality (procedure-related death) was 6.3% due to sepsis.CONCLUSION: The mean PFS was inversely affected by the number of treatment lines received prior to ASCT.

Significance of HER2 protein expression and HER2 gene amplification in colorectal adenocarcinomas.

BACKGROUNDHuman epidermal growth factor receptor 2 (HER2) is an oncogenic driver, and a well-established therapeutic target in breast and gastric cancers. While the role of HER2 as a prognostic biomarker in colorectal adenocarcinomas (CRCs) remains uncertain, its relevance as a therapeutic target has been established. We undertook the present study to evaluate the frequency of HER2 expression in CRC and to correlate it with various clinicopathological variables.AIMTo correlate HER2 protein expression and HER2 gene amplification with clinicopathological features and survival in surgically resected CRC.METHODSAbout 1195 consecutive surgically resected CRCs were analyzed by immunohistochemical staining (IHC) to assess HER2 protein expression, and 141 selected tumors were further evaluated by fluorescence in situ hybridization (FISH) to assess HER2 gene amplification. Follow-up information was available for 1058 patients, and using this information we investigated the prevalence of HER2 protein overexpression and gene amplification in a large series of surgically resected CRCs, and evaluated the relationship between overexpression and clinicopathological parameters and prognosis.RESULTSHER2 IHC scores of 3+, 2+, 1+, and 0 were seen in 31 (2.6%), 105 (8.8%), 475 (39.7%), and 584 (48.9%) tumors, respectively. HER2 gene amplification was seen in 24/29 tumors with an IHC score of 3+ (82.8%; unreadable in 2/31), 12/102 tumors with an IHC score of 2+ (11.8%; unreadable in 2/104), and 0 tumors with IHC score of 1+ (0/10). HER2 gene amplification was seen in 36/1191 tumors (3.0%; unreadable in 4/1195). Among the tumors with HER2 IHC scores of 3+ and 2+, the mean percentage of tumor cells with positive IHC staining was 90% (median 100%, range 40%-100%) and 67% (median 75%, range 5%-95%), respectively (P < 0.05). Among tumors with IHC scores of 2+, those with HER2 gene amplification had a higher number of tumors cells with positive IHC staining (n = 12, mean 93%, median 95%, range 90%-95%) than those without (n = 90, mean 70%, median 50%, range 5%-95%) (P < 0.05). HER2 gene status was significantly associated with distant tumor metastasis and stage (P = 0.028 and 0.025). HER2 protein overexpression as measured by IHC or HER2 gene amplification as measured by FISH was not associated with overall survival (OS) or disease-specific survival for the overall group of 1058 patients. However, further stratification revealed that among patients with tubular adenocarcinomas who were 65 years old or younger (n = 601), those exhibiting HER2 gene amplification had a shorter OS than those without (mean: 47.9 mo vs 65.1 mo, P = 0.04). Among those patients with moderately to poorly differentiated tubular adenocarcinomas, those with positive HER2 tumor IHC scores (2+, 3+) had a shorter mean OS than those with negative HER2 IHC scores (0, 1+) (47.2 mo vs 64.8 mo, P = 0.033). Moreover, among patients with T2 to T4 stage tumors, those with positive HER2 IHC scores also had a shorter mean OS than those with negative HER2 IHC scores (47.1 mo vs 64.8 mo, P = 0.031).CONCLUSIONHER2 protein levels are correlated with clinical outcomes, and positive HER2 expression as measured by IHC confers a worse prognosis in those patients 65 years old or younger with tubular adenocarcinomas.

Identifying prognostic intratumor heterogeneity using pre- and post-radiotherapy 18F-FDG PET images for pancreatic cancer patients.

To stratify risks of pancreatic adenocarcinoma (PA) patients using pre- and post-radiotherapy (RT) PET/CT images, and to assess the prognostic value of texture variations in predicting therapy response of patients. Twenty-six PA patients treated with RT from 2011-2013 with pre- and post-treatment 18F-FDG-PET/CT scans were identified. Tumor locoregional texture was calculated using 3D kernel-based approach, and texture variations were identified by fitting discrepancies of texture maps of pre- and post-treatment images. A total of 48 texture and clinical variables were identified and evaluated for association with overall survival (OS). The prognostic heterogeneity features were selected using lasso/elastic net regression, and further were evaluated by multivariate Cox analysis. Median age was 69 y (range, 46-86 y). The texture map and temporal variations between pre- and post-treatment were well characterized by histograms and statistical fitting. The lasso analysis identified seven predictors (age, node stage, post-RT SUVmax, variations of homogeneity, variance, sum mean, and cluster tendency). The multivariate Cox analysis identified five significant variables: age, node stage, variations of homogeneity, variance, and cluster tendency (with P=0.020, 0.040, 0.065, 0.078, and 0.081, respectively). The patients were stratified into two groups based on the risk score of multivariate analysis with log-rank P=0.001: a low risk group (n=11) with a longer mean OS (29.3 months) and higher texture variation (>30%), and a high risk group (n=15) with a shorter mean OS (17.7 months) and lower texture variation (<15%). Locoregional metabolic texture response provides a feasible approach for evaluating and predicting clinical outcomes following treatment of PA with RT. The proposed method can be used to stratify patient risk and help select appropriate treatment strategies for individual patients toward implementing response-driven adaptive RT.

Analysis of prognosis-related factors for pancreatic neuroendocrine tumors

Objective To analyze retrospectively the clinicopathological characteristics of pancreatic neuroendocrine tumors(PNETs) and investigate the prognosis-related factors associated with tumor recurrence and survival. Methods Data of 96 patients with PNETs were analyzed retrospectively. Results A total 76 patients was included in this study, 65 patients in surgery group, and 11 in non-surgery group. The mean overall survival in surgery group was (36.6±30.4)months. The 1-, 3-, and 5-year overall survival rates were 95.4%, 84.6%, and 84.6%, respectively. Multivariate analysis showed that lymph node metastasis, G3 histological grade, and major vascular invasion were significantly associated with survival of PNETs (P<0.05). The mean disease-free survival was (31.5±29.1)months. The 1-, 3-, and 5-year disease-free Survival rates were 12.3%, 24.6%, and 29.2%, respectively. Multivariate analysis showed that lymph node metastasis and pancreatic neuroendocrine carcinoma were significantly associated with recurrence of PNETs (P<0.05). The mean overall survival in non-surgery group was (15.0±10.3) months. The 1-, and 3-year overall survival rates were 63.6% and 36.4%, respectively. Compared to 6 patients presented distant metastasis in surgery group, the non-surgery group is associated with a shorter mean overall survival(OS)[(15.0±10.3)months vs (39.3±42.1)months], and lower 1-, and 3-year overall survival rate. Conclusions Lymph node metastasis, G3 histologcial grade, and major vascular invasion were independent predictive factors of worse overall survival in patients with PNETs. Lymph node metastasis and pancreatic peuroendocrine carcinoma were found to be independent risk factors influencing recurrence. In series of patients of PNETs with advance stage, surgery seemed to improve survival, but further study is needed. Key words: Pancreatic neoplasms; Neuroendocrine tumors; Prognosis; Risk factors